Where Does Hypoglossal Nerve Stimulator Implant Fit in the Surgical Management Algorithm of Obstructive Sleep Apnea? 

by Ameya A. Asarkar, MD, FACS, Roger Bui, MD, Jason Calligas, MD, M. Boyd Gillespie, MD, and Cherie-Ann O. Nathan, MD, FACS •

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BACKGROUND

Hypoglossal nerve stimulation (HGNS) implant has been an effective therapeutic option in select patients with moderate to severe obstructive sleep apnea (OSA) since the recommendations based on the Stimulation Therapy for Apnea Reduction (STAR) trial were published in 2014. Several studies have reported satisfactory real-world treatment effectiveness, adherence, and subjective patient outcomes. Ongoing research and published patient outcomes have expanded the eligibility criteria for OSA patients undergoing HGNS implants. Recently, the U.S. Food and Drug Administration (FDA) approved the HGNS implant in adolescents with Down syndrome with OSA and positive airway pressure (PAP) intolerance. The current review outlines the role and future directions of HGNS implantation in the treatment algorithm of OSA patients who are intolerant of or non-compliant with PAP modalities.

BEST PRACTICE

OSA is a growing medical problem and a prominent risk factor for the development of several chronic systemic diseases. HGNS therapy is an effective and safe surgical option for patients with moderate to severe OSA who cannot tolerate PAP therapy. Approval of Inspire therapy to include pediatric patients 13 years of age or older with Down syndrome demonstrates that HGNS is a compelling therapy with good adherence even in the pediatric population. The FDA has further approved patients’ eligibility for HGNS to include an apnea–hypopnea index of up to 100 events/h and body mass index of up to 40 kg/m. Research in this cohort is evolving. Ongoing research has refined the surgical techniques, improved outcomes with the existing HGNS implant systems, and shown promise in developing newer systems that may serve as another tool in the surgical treatment of OSA.